Instrumento para identificar barreras ambientales percibidas por personas mayores en el contexto cubano / An Instrument for Identifying Environmental Barriers Perceived by Elderly People in the Cuban Context

Introducción: El envejecimiento de la población cubana trae aparejado un aumento de la discapacidad. En este sentido la Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud recomienda el diseño de instrumentos de medición que identifiquen los factores ambientales que afectan la funcionalidad. Objetivo: Describir las propiedades psicométricas de un instrumento de medición diseñado para identificar barreras ambientales percibidas por las personas mayores en el contexto cubano en cuanto a la validez de apariencia, de contenido y constructo. Métodos: Se realizó un estudio de desarrollo tecnológico. Se consultó a un grupo de expertos para la validación de apariencia y contenido, y se calculó el coeficiente de validez de contenido insesgado y corregido. Para la validez de constructo se calculó el análisis factorial de los componentes principales. Resultados: El coeficiente de validez de contenido insesgado y el corregido mostraron cifras superiores a 0,80, considerado como bueno. El análisis factorial arrojó siete factores que explican las dimensiones exploradas en la definición que se pretende medir. Conclusiones: El instrumento diseñado mostró un alto acuerdo entre los expertos en cuanto a la validez de apariencia y contenido. Los indicadores evidenciaron que el instrumento tiene una estructura multidimensional que se corresponde con el constructo que se pretende medir(AU)

Introduction: The aging of the Cuban population brings about an increase in disability. In this sense, the International Classification of Functioning, Disability and Health recommends the design of measurement instruments to identify environmental factors affecting functionality. Objective: To describe, in terms of face, content and construct validity, the psychometric properties of a measurement instrument designed to identify environmental barriers perceived by elderly people in the Cuban context. Methods: A technological development study was carried out. A group of experts was consulted for the face and content validation, while the unbiased and corrected content validity coefficient was calculated. For construct validity, principal component factor analysis was calculated. Results: The unbiased and corrected content validity coefficient showed figures above 0.80, considered as good. Factor analysis yielded seven factors that explain the dimensions explored in the definition intended to be measured. Conclusions: The designed instrument showed high agreement among the experts in terms of face and content validity. The indicators showed that the instrument has a multidimensional structure that corresponds to the construct that it is intended to measure(AU)

Evaluation of saliva pools method for detection of congenital human cytomegalovirus infection.

Human cytomegalovirus (HCMV) is the most frequent cause of congenital infection, leading to long-term sequelae especially sensorineural hearing loss (SNHL). Since 5-15 % of the asymptomatic newborns will develop late sequelae, the implementation of a universal screening would allow the identification of infected children and early intervention. The aim of this study was to validate the use of saliva pools of 10 and 20 samples for the detection of HCMV congenital infection. Four spiking samples (negative saliva matrix added with known concentration of AD169 strain culture supernatant) and a set of 12 saliva samples, collected from newborns with confirmed congenital infection in their first three weeks of life, were tested individually and after dilution in 10 and 20 pools by an "in-house" RT-PCR. Both pool methodologies, 10-pool and 20-pool samples, had 100 % sensitivity and specificity when compared with individual samples. This methodology could allow a cost reduction close to 85 % and 89 %, respectively for the 10-pool and 20-pool approach, when compared with testing each sample individually. This significant reduction may open the possibility to perform the newborn screening for HCMV in a large-scale.

Morphometric hemispheric asymmetry of orbitofrontal cortex in women with borderline personality disorder: a multi-parameter approach.

Functional imaging studies have implicated the orbitofrontal cortex (OFC) in the pathophysiology of borderline personality disorder (BPD). To date, however, volume-based magnetic resonance imaging (MRI) studies have yielded mixed results. We used a surface-based processing approach that allowed us to measure five morphometric cortical features of the OFC, including volumetric (cortical thickness and surface area) and geometric (mean curvature, depth of sulcus, and metric distortion - three indicators of cortical folding) parameters. Participants comprised 25 female BPD patients with no other current psychiatric comorbidity and 25 age- and gender-matched healthy controls who received structural MRI scans. Images were processed using the Freesurfer package. All BPD patients had a history of comorbid psychiatric disorder(s) and were currently on medications. Compared with controls, the BPD group showed reduced cortical thickness, surface area, mean curvature, depth of sulcus, and metric distortion in the right medial OFC. In the left medial OFC, the BPD group had reduced cortical thickness and mean curvature, but increased metric distortion. This study confirmed the utility of surface-based analysis in the study of BPD cortical structures. In addition, we observed extensive structural abnormalities in the medial OFC of female subjects with BPD, findings that were most pronounced in the right OFC, with preliminary data suggesting hemispheric asymmetry.

Cortical morphology changes in women with borderline personality disorder: a multimodal approach.

OBJECTIVE: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. METHODS: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. RESULTS: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. CONCLUSION: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters.

Cortical morphology changes in women with borderline personality disorder: a multimodal approach

Objective: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters. .

O ensino de psicoterapia psicanalítica no departamento de psiquiatria da escola paulista de medicina - Universidade Federal de São Paulo - UNIFESP / Psychoanalytic Psychotherapy Teaching in the Department of Psychiatry of the School of Medicine - Universidade Federal de São Paulo - UNIFESP

Este artigo apresenta o ensino de psicoterapia no Departamento de Psiquiatria da Escola Paulista de Medicina - UNIFESP, referindo-se às psicoterapias de base psicanalítica e salientando sua importância na formação de residentes de psiquiatria. Apresenta-se, por meio de seu histórico, a herança psicodinâmica deste departamento e intrínseca ligação com o programa de residência médica. São descritos o conteúdo teórico do curso, o modelo de funcionamento de assistência a pacientes previdenciários e o processo de avaliação do ensino nos últimos anos. Esta avaliação constitui-se em objeto de pesquisa sobre o ensino de psicoterapia para residentes e estagiários de primeiro e segundo anos, cuja metodologia incluiu a realização de questionário de autoavaliação e cadernos de registros de sessões produzidos por todos os alunos-terapeutas no período de dois anos. São apresentadas algumas respostas e trechos de sessões com reflexões dos supervisores que mostram o desenvolvimento da dupla psicoterapeuta-paciente. Por fim, comentam-se as limitações e dificuldades dessa tarefa tanto no âmbito das demandas da medicina baseada em evidências, da psiquiatria contemporânea como das diferenças entre ensino e formação de psicoterapeutas.(AU)

This study presents the teaching of psychotherapy in the Department of Psychiatry of the Universidade Federal de São Paulo - UNIFESP, referring to psychoanalytical psychotherapies and reinforcing its significance in the formation of the psychiatry resident. Through its history, the psychodynamic heritage of this department is presented as well as its underlying connection with the medical residency program. The theoretical content of the course, the government funded health care model and the evaluation process of teaching over the last years are described. This evaluation is a research subject in itself, one about teaching psychotherapy to first and second year medical residents and Psychology trainees using a methodology that includes a selfassessment questionnaire fulfilled and session notes taken by each studenttherapist during a two year period. Some answers and session extracts with reflections by the supervisor are presented to demonstrate the development of the psychotherapist-patient dyad. Finally, limits and difficulties of this task are commented on, both in terms of evidence-based medicine and contemporary psychiatry demands and of differences between teaching and formation of psychotherapists.(AU)

Rorschach and the WAIS-III after one and two years of psychotherapy / O teste de Rorschach e a Escala WAIS-III após um e dois Anos de psicoterapia

This study aimed at identifying what aspects of personality are modified after one and two years of psychoanalytic psychotherapy in adults attending a free university healthcare service in São Paulo, Brazil. The instruments were the Rorschach and the WAIS-III tests which were administered before and after one and two years of treatment. The participants were 34 adult individuals, both genders. After one year of psychotherapy in the Rorschach method there was an increase in effective and adaptive interpersonal relationship, an enhancement in sensitiveness related to the capacity of modulating affect, the need for close contact as well as the arousal of feelings of discomfort associated with intensification of self-regard, and a decrease in narcissistic tendencies. As well as in WAIS-III, there was an increase in motivation, attention and speed processing.(AU)

O estudo teve por objetivo identificar quais aspectos da personalidade são modificados após um e dois anos de psicoterapia psicanalítica em adultos atendidos em um serviço público de saúde mental de uma universidade em São Paulo, no Brasil. Os instrumentos utilizados foram o Rorschach e a Escala de Inteligência Wechsler para adultos (WAIS-III), os quais foram administrados antes e após um e dois anos de tratamento. Os participantes foram 34 indivíduos adultos, de ambos os sexos. No Rorschach, após um ano de psicoterapia, ocorreu melhora da relação interpessoal adaptada e efetiva, melhora na sensibilidade relacionada à capacidade de modular afeto e da necessidade de contato mais próximo, e surgimento de sentimentos de desconforto associados à intensificação de auto-observação e diminuição de tendências narcisistas. No WAIS-III houve aumento de motivação, melhora atencional e de velocidade de processamento.(AU)

Rorschach and the WAIS-III after one and two years of psychotherapy / O teste de Rorschach e a Escala WAIS-III após um e dois Anos de psicoterapia

This study aimed at identifying what aspects of personality are modified after one and two years of psychoanalytic psychotherapy in adults attending a free university healthcare service in São Paulo, Brazil. The instruments were the Rorschach and the WAIS-III tests which were administered before and after one and two years of treatment. The participants were 34 adult individuals, both genders. After one year of psychotherapy in the Rorschach method there was an increase in effective and adaptive interpersonal relationship, an enhancement in sensitiveness related to the capacity of modulating affect, the need for close contact as well as the arousal of feelings of discomfort associated with intensification of self-regard, and a decrease in narcissistic tendencies. As well as in WAIS-III, there was an increase in motivation, attention and speed processing.

O estudo teve por objetivo identificar quais aspectos da personalidade são modificados após um e dois anos de psicoterapia psicanalítica em adultos atendidos em um serviço público de saúde mental de uma universidade em São Paulo, no Brasil. Os instrumentos utilizados foram o Rorschach e a Escala de Inteligência Wechsler para adultos (WAIS-III), os quais foram administrados antes e após um e dois anos de tratamento. Os participantes foram 34 indivíduos adultos, de ambos os sexos. No Rorschach, após um ano de psicoterapia, ocorreu melhora da relação interpessoal adaptada e efetiva, melhora na sensibilidade relacionada à capacidade de modular afeto e da necessidade de contato mais próximo, e surgimento de sentimentos de desconforto associados à intensificação de auto-observação e diminuição de tendências narcisistas. No WAIS-III houve aumento de motivação, melhora atencional e de velocidade de processamento.

Avaliação da disciplina observação da prática médica pelos graduandos de medicina da Unifesp - Escola Paulista de Medicina / Medical students' assessment of the course on observation of medical practice at the Unifesp School of Medicine

Discute-se a necessidade de cuidar, no campo afetivo, das relações estabelecidas entre médicos e pacientes, o que depende de modelos de humanização durante o ensino médico. Em 2003, a Unifesp iniciou uma unidade curricular (UC) que propôs a Observação das Práticas Médicas (OPM) aos primeiranistas do curso médico. Após a observação, seguia-se uma discussão das experiências de modo expositivo e reflexivo, com professores de diversas subáreas. O objetivo do estudo foi avaliar a influência imediata e ao longo do tempo desta UC sobre 30 graduandos de Medicina do primeiro ao terceiro ano (dez por ano), utilizando um questionário de abordagem quantitativa (cinco questões de múltipla escolha) e qualitativa (três questões abertas, categorizadas após análise e consenso dos dois autores). Concluiu-se que a UC permitiu a apresentação de práticas médicas aos iniciantes, que tinham pouco contato com as mesmas. Ao longo dos anos, observou-se uma modificação na percepção dos alunos sobre a OPM: os alunos das primeiras séries valorizaram o acolhimento emocional, enquanto os de séries mais adiantadas, o conhecimento do seu campo de aprendizado e atuação futura.

The article discusses the need to deal with physician-patient relations at the affective level, which requires models for humanization of care during undergraduate medical training. In 2003, the UNI-FESP School of Medicine launched a course on Observation of Medical Practices as part of the regular curriculum for first-year medical students. The observation was followed by discussion of experiences with lectures, reflection, and debate with medical faculty from various specialties. The aim of the study was to assess the immediate and long-term impact of the course on the 30 first to third-year undergraduates (10 students per year), using a quantitative (5 multiple-choice questions) and qualitative questionnaire (3 open questions, categorized after analysis and consensus between the two authors). The authors concluded that the course allowed presentation of medical practices to the early medical undergraduates, who had little previous contact with this reality. Over the course of the years, a change was observed in the students' perception of Observation of Medical Practice: students in the initial years tended to value emotional support for patients, while as the years went by the undergraduates focused more on the knowledge in their field of learning and their future professional work.

Psychic changes: the rorschach, the psychoanalytical process and the analyst-analysand relationship / Cambios psíquicos: el rorschach, el proceso psicoanalítico y la relación analista-analizando

The authors intend to articulate the clinical and theoretical frames of references in an empirical context of a psychoanalytical investigation. Four young women with borderline disorder were assisted in psychoanalytic psychotherapy at the outpatient psychotherapeutic public service of a Medical School. The Rorschach test, Comprehensive System, was administrated before the treatment and once a year. After one year of therapy it was possible to correlate the participants’ psychic changes detected by the Rorschach with the changes occurred in the psychoanalytic setting. In some situations, it was possible for the analyst to build together with the analysand new representations and elaborations. In other moments, due to the violence and intensity of the emotions lived in the experience with the analysand, acting outs were enacted by the therapist, what could be recognized and overcome latter.(AU)

Las autoras intentan articular marcos de referencia clínicos y teóricos en el contexto empírico de una investigación psicoanalítica. Cuatro mujeres jóvenes con trastornos borderline fueron tratadas con psicoterapia psicoanalítica en el servicio público de consultorios externos de una facultad de medicina. El Rorschach, Sistema Comprehensivo, fue administrado antes del tratamiento y luego, una vez por año. Después de un año de terapia fue posible correlacionar los cambios psíquicos de las participantes detectados por el Rorschach con los cambios ocurridos en el encuadre psicoanalítico. En algunas situaciones, fue posible para el analista construir junto con la analizanda nuevas representaciones y elaboraciones. En otros momentos, debido a la violencia e intensidad de las emociones vividas en la experiencia con la analizanda, se desencadenaron actuaciones en el terapeuta que pudieron ser reconocidas y superadas posteriormente(AU)

Psicanálise e Universidade: a interface possível por meio da pesquisa psicanalítica clínica. Alice quebra-vidros / Psychoanalysis and University: the potential interface through psychoanalytic clinical research. Alice Glass-breaker

As relações entre Psicanálise, Ciência e Universidade são antigas. Remontam à época de Freud e têm se mostrado tema importante para a Psicanálise no século XXI. Os psicanalistas que trabalham nas Universidades sofrem demandas por evidenciar o funcionamento e os resultados de sua disciplina. Este artigo comenta os modelos possíveis de pesquisa psicanalítica e defende a pesquisa clínica de caso individual por meio do próprio método psicanalítico acrescido por elementos da pesquisa qualitativa. Para tanto, as autoras estudam o processo de psicoterapia psicanalítica e o funcionamento mental de uma paciente borderline atendida durante quatro anos em uma clínica universitária pública. Aproximadamente 120 sessões foram registradas de um total de 340 sessões. Estas foram lidas e relidas como se fossem narrativas pela psicanalista investigadora, revelando momentos significativos do trabalho da dupla analista-paciente.

The relationships between Psychoanalysis, Science and Universities have been discussed since Freud and gained relevance over the 21st century as an important subject for Psychoanalysis. Psychoanalysts who work in Universities are supposed to conduct research. This article comments on possible psychoanalytical research models and supports individual case clinical research through the psychoanalytical method itself, added on qualitative research elements. The authors study the psychoanalytical psychotherapy process and the mental functioning of a borderline patient treated for four years in a public university institution. Approximately 120 of 340 sessions were registered. They were read and re-read by the investigator-psychoanalyst as if they were narratives and revealed some meaningful developments from the psychoanalyst-patient.

[Psychoanalysis and University: the potential interface through psychoanalytic clinical research. Alice Glass-breaker]. / Psicanálise e Universidade: a interface possível por meio da pesquisa psicanalítica clínica. Alice quebra-vidros.

The relationships between Psychoanalysis, Science and Universities have been discussed since Freud and gained relevance over the 21st century as an important subject for Psychoanalysis. Psychoanalysts who work in Universities are supposed to conduct research. This article comments on possible psychoanalytical research models and supports individual case clinical research through the psychoanalytical method itself, added on qualitative research elements. The authors study the psychoanalytical psychotherapy process and the mental functioning of a borderline patient treated for four years in a public university institution. Approximately 120 of 340 sessions were registered. They were read and re-read by the investigator-psychoanalyst as if they were narratives and revealed some meaningful developments from the psychoanalyst-patient.

Dois vértices da investigação de pacientes borderline: a clínica psicanalítica e a avaliação psicológica. Alice quebra-vidros / Two frames of reference in research on borderline patients: the psychoanalytic clinic and the psychological evaluation. Alice Glass-breaker

As autoras apresentam alguns aspectos da clínica psicanalítica de uma paciente, Alice, com diagnóstico de transtorno de personalidade borderline ou fronteiriço. Dois vértices são empregados: a psicoterapia psicanalítica e a avaliação pelo método de Rorschach durante quatro momentos de seu tratamento. Iniciam com uma breve revisão da literatura sobre pacientes borderline seguida do caso clínico Alice em que discutem questões relacionadas ao processo psicoterapêutico psicanalítico (transferência, contratransferência e atuações) e ao funcionamento mental da paciente (mentalização, capacidade simbólica, percepção das realidades interna e externa). Um resumo das avaliações psicológicas é também comentado.

Delimitation of homogenous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators

Context: The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. Objective: To identify homogenous regions in the UNIFESP/EPM healthcare center (HCC) coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. Design: Secondary data analysis. Setting: HCC coverage area; primary care. Sample: Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. Main measures: Proportion of children and elderly in the population; family providers' education level (maximum: > 15 years, minimum: < 1 year) and income level (maximum: > 20 minimum wages, minimum: < 1 minimum wage); proportional mortality distribution. Results. The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p<0.05) difference between the first region (least affluent) and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. Conclusion: The inequalities observed may contribute to primary health prevention.

Psicoses e puerpério: um estudo sobre a semiologia e a situaçäo nosológica das chamadas "psicoses puerperais" / Psychoses and puerperium: a estudy on the symptomatology and the nosological categorization of the so called \"puerperal psychoses\"

O presente trabalho refere-se à semiologia e situaçäo nosológica das chamadas psicoses puerperais. Os autores estudaram, retrospectivamente, 18 puérperas internadas em uma enfermaria psiquiátrica em hospital de ensino. Foram estudados dados demográficos, início dos sintomas em relaçäo ao parto, antecedentes psiquiátricos, história ginecológica e obstetrícia e tratamento. As pacientes foram diagnosticadas através da aplicaçäo retrospectiva do RDC (Research Diagnostic Criteria), encontrando-se os seguintes agrupamentos nosológicos: distúrbios esquizofrênicos, afetivos e um terceiro grupo, caracterizado por distúrbios da consciência. Os sintomas, avaliados de acordo com BPRS (Brief Psychiatric Rating Scale) modificada, foram compatíveis com os diagnósticos obtidos pelo RDC. Os dados mostraram a heterogeneidade dos distúrbios psicóticos que ocorrem no puerpério e indicam a importância dos quadros confusionais, que ocorreram em um terço das puérperas estudadas. Os autores enfatizam a necessidade de estudos específicos a respeito desse subgrupo de psicoses puerperais, caracterizado por distúrbio da consciência e sem antecedentes de psicose funcional prévia

Psicoses e puerperio: um estudo sobre a semiologia e a situacao nosologica das chamadas "psicoses puerperais"

O presente trabalho refere-se a semiologia e situacao nosologica das chamadas psicoses puerperais. Os autores estudaram, retrospectivamente, 18 puerperas internadas em uma enfermaria psiquiatrica em hospital de ensino. Foram estudados dados demograficos, inicio dos sintomas em relacao ao parto, antecedentes psiquiatricos, historia ginecologica e obstetrica e tratamento. As pacientes foram diagnosticadas atraves da aplicacao retrospectiva do RDC (Research Diagnostic Criteria), encontrando-se os seguintes agrupamentos nosologicos: disturbios esquizofrenicos, afetivos e um terceiro grupo, caracterizado por disturbios da consciencia. Os sintomas, avaliados de acordo com a BPRS (Brief Psychiatric Rating Scale) modificada, foram compativeis com os diagnosticos obtidos pelo RDC. Os dados mostraram a heterogeneidade dos disturbios psicoticos que ocorrem no puerperio e indicam a importancia dos quadros confusionais, que ocorrem em um terco das puerperas estudadas. Os autores enfatizam a necessidade de estudos especificos a respeito desse subgrupo de psicoses puerperais, caracterizado por disturbios da consciencia e sem antecedentes de psicose funcional previa.